My story raising questions about a Texas task force’s selection of Parkland Memorial Hospital and UT Southwestern Medical Center to head up a new Ebola treatment center has prompted a strange response from Parkland.

One of its senior executives accuses me in a press statement this week of bamboozling some of the most prominent health-care experts in the industry, and my news organization of trying to divide Dallas’ medical community.

First, some quick background. My Oct. 24 article featured three national experts on hospital management who in recent years have expressed concerns about Parkland’s approach to patient safety or transparency. Until late last year, Parkland and UTSW were at the center of a rare two-year federal safety intervention to try to remedy what regulators called life-threatening failures in infection control and other practices at Parkland. UTSW oversees the hospital’s clinical care.

After they were tapped as the operators of the newly created Ebola center, I naturally revisited that history in interviews with the experts. It’s my responsibility as a watchdog reporter to follow up on such issues. The professionals in turn questioned whether the task force had considered the safety record of both institutions. They also called for transparency about whether Parkland and UTSW have tackled the longstanding problems in their academic partnership.

Consultants and government officials have warned over the years that their differences - divergent missions, turf battles and clashing business interests - must be fixed to ensure effective patient care. Officials with Parkland and UTSW have not responded to our questions about those issues, highlighted in our 2013 Chronic Condition investigation.

Back to the Parkland complaint. Michael Malaise, a senior public affairs executive with Parkland, circulated an email to Dallas “opinion leaders and media” alleging that I had made false claims in my conversations with the experts intended to “coax a particular response from them.” He also accused The Dallas Morning News, whose ongoing investigation triggered the unusual federal crackdown, of being “obsessed with promoting discord” within the local medical community.

For the record, we understand the enormous task Parkland employees have confronted in overhauling their hospital’s operations over the last three years. But the public shouldn’t confuse our investigative reporting with promoting discord.

Also, the experts in my story weren’t in any way misled. To the contrary, they said they found my approach – and the story – fair and accurate.

On Tuesday the public learned that the private company managing Parkland Memorial Hospital’s psychiatric department can’t even keep track of how many psychiatrists work there or how many patients they’re treating.

This may seem mind boggling. How can a psychiatric firm not have control over the psychiatrists under its watch?

The same way Parkland has for years exerted little to no control over the doctors working under its own roof.

As our 2013 investigative series Chronic Conditiondisclosed, UT Southwestern Medical Center actually employs and controls the vast majority of doctors, including residents-in-training, at Parkland. Under a longstanding contract, UTSW essentially has acted as a shadow government inside the taxpayer-funded hospital.

As patient care deteriorated over the years, that staffing structure made it difficult for Parkland officials to keep tabs on whether doctors, including psychiatrists, are actually present in the building or supervising residents. When Parkland officials tried to secure commitments from UTSW to dedicate more doctors to the psych department and other units, they frequently hit resistance. Power struggles became common. Relations sometimes turned to “vitriol,” contract negotiations were a “cage match.”

That was the history Green Oaks stepped into in February 2013 when Parkland hired it to manage its troubled psych services. The move was intended to help fix widespread care failures at Parkland while it was still under a rare form of government oversight. In previous months, federally installed safety monitors had been faulting UTSW psychiatrists for not spending adequate time overseeing Parkland’s mentally ill patients.

But one bit of unfinished business remained. The trauma surgeon sought damages in state court over his 2007 demotion. That was, he said, an act of retaliation after he had blown the whistle to his department chairman.

On Monday, Gentilello’s bid was dealt a blow when an appeals court ruled that a powerful legal shield enjoyed by state agencies protected UTSW against this case as well.

The 5th District Court of Appeals in Dallas sided with a lower court in arriving at its decision. It did not delve into the substance of Gentilello’s billing fraud allegations. Instead it addressed whether the case could proceed in light of the sovereign immunity doctrine. (The opinion is at end of this post.)

The chief medical officer during Parkland Memorial Hospital’s years-long safety crisis is now overseeing one of the nation’s most famous health institutions.

Dr. John Jay Shannon was promoted Friday to interim chief executive at Chicago’s Cook County Health & Hospitals System. That puts him over John H. Stroger Jr. Hospital, inspiration for the television show ER.

Shannon has been there less than a year as a high-level clinical administrator. He temporarily replaces the man who hired him. Dr. Ramanathan Raju, who is taking a job in New York, said last year that Shannon’s role in Dallas hadn’t troubled him.

The Tribune reported Friday that “Shannon said he learned from the problems at Parkland, which he attributed in part to attempts to increase the volume of patient care and improve efficiency at the hospital, moves that he said led to lapses in safety.”

Aivar Bracka denied wrongdoing but admitted exposing himself to some patients.

The British penile reconstruction expert lost his medical license after regulators found that he sexually abused young patients. Then a UT Southwestern Medical Center official arranged a short teaching stint for him at a Dallas children’s hospital.

These are among the revelations in records recently obtained by The Dallas Morning News. It’s the second case to emerge this year in which some UTSW officials turned a blind eye to physicians who’d been disciplined over abuse complaints.

“Because the judgment exercised was viewed as inconsistent with our values and expectations of our leaders, he was removed from his role as division chief,’’ a UTSW statement said. Administrators “would not have approved this invitation” if they had known about it.

Dr. Warren Snodgrass

Snodgrass has also lost his title as chief of urology at Children’s. He has not commented publicly.

His dealings with Bracka raise questions about whether UTSW and Children’s check the qualifications of all visiting faculty. Policies released by UTSW say nothing about requiring such checks.

No policy changes are planned because “this was determined to primarily reflect a lapse in judgment,” UTSW said. “It is our expectation that irrespective of policy, faculty will exercise judgment and act in accordance with our values that are consistent with our missions and the trust placed in us as an institution.”

Children’s said it checks the credentials of everyone who “will be involved in direct patient care or have direct patient contact.” Bracka, the hospital said, had no such duties, so “there was no need to credential him.”

But Children’s nevertheless has serious concerns about the matter, hospital spokeswoman Patty Sullivan said today. UTSW, she said, did not disclose Bracka’s background before he moderated a two-day penile surgery workshop in 2011. He spoke in a Children’s auditorium where doctors watched live video of surgeries being performed on boys.

“We have expectations of our physicians in positions of leadership that they’re going to use good judgment,” Sullivan said. “Parents are putting their children in our hands, and it’s a sacred trust.”

‘Little insight’

Bracka was once a top international authority on repairing a male genital birth defect called hypospadias. But his career has been crumbling publicly since 2007, when British medical authorities barred him from seeing patients without a chaperone. Two years later, he was acquitted in a criminal trial of indecently assaulting patients, but also suspended from practicing medicine. His license was revoked in late 2010, with regulators finding that he performed sexual acts on or in the presence of five adolescent boys and a young man.

He did this under the guise of showing them how they would look and function after surgery, according to regulators, and then initiated sexual encounters — usually masturbation, but also oral sex in one case. “Bracka has shown little insight into the gravity of his actions,” the regulators wrote.

Bracka and his lawyer in London did not respond to interview requests.

UTSW records say Snodgrass invited Bracka in early 2010 to teach for four days in March 2011. Snodgrass learned of the license revocation months before Bracka arrived but didn’t see the exposure admission until after he departed, the records say.

Bracka provoked controversy on his first day of teaching, during a lecture at UTSW about men’s genital diseases. The next day, UTSW’s urology department chairman began emailing Snodgrass about his concerns.

Dr. Claus Roehrborn

First, wrote Dr. Claus Roehrborn, doctors at the session “had done extensive web research” about the license revocation. That “must have affected the lecture and how it was perceived somewhat.”

Second, Bracka made “frequent comments about ‘good looking penises’ and said that “to make up for lost time he screwed anybody and anything,” Roehrborn wrote. Records released by UTSW don’t explain the context for Bracka’s remarks.

Patient care?

After the lecture, Bracka was scheduled to answer questions from less experienced doctors about their cases and to see at least one UTSW patient. It isn’t clear from the records whether that happened.

Sullivan, the Children’s spokeswoman, said “he did not demonstrate any surgical techniques.” Montoya’s letter, she said, used “general language” from the hospital’s contract with Bracka. It was intended “to indicate that during the conference the physician audience would be viewing real-time surgical case demonstrations and Dr. Bracka, as the moderator, would speak to the surgical techniques being performed.”

The letter went to Texas Attorney General Greg Abbott as part of an effort — so far successful — to keep The News from seeing the contract.

Before flying home to England, Bracka took a two-day beach vacation with Snodgrass. Joining them in Galveston was another visiting professor who performed surgery during the workshop.

Snodgrass responded to his chairman’s concerns by apologizing for not telling him about the license revocation. “I should have discussed this with you,” he wrote in an email.

“I have known Aivar for some time, and have greatly benefited from my professional interactions with him,” added Snodgrass. He noted Bracka’s reputation as a penile surgery expert and said: “It was only in that spirit that I invited him.”

Snodgrass, who also has an international reputation, said some in Britain blamed the license revocation on “political correctness.”

Roehrborn responded by focusing on his practical concerns. “Many hospitals/medical schools,” he told Snodgrass, “could not use funding to support a visiting doctor who has lost his license.”

‘You have little choice’

Children’s, a private nonprofit entity, paid for Bracka’s air travel and $2,000 honorarium, records show. UTSW, a state institution, paid for the other visiting professor.

UTSW also obtained a temporary license to practice medicine for the other visitor, Texas Medical Board records show. But the university did not obtain one for Bracka.

A visiting professor who “exercises medical judgment, renders an opinion or gives advice concerning the diagnosis or treatment of a patient” is considered to be practicing medicine, according to medical board rules. Such a visitor would need a Texas license.

Board spokeswoman Megan Goode said she could not answer specific questions about Bracka. “But hypothetically, an applicant with this type of history certainly would have raised concerns and very likely would have been denied a license,” she said.

When emailing with his chairman, Snodgrass said Bracka remained in high demand as a visiting professor and would serve in that role later in 2011 at Seattle Children’s Hospital.

A few days later, a Seattle colleague emailed Snodgrass to say, “I need to talk to you privately ASAP.” Their ensuing communications apparently led Snodgrass to read details of the British license revocation case for the first time.

“There is a statement that Aivar admitted to exposing his penis to a few patients, and that alone is enough of a problem,” Snodgrass wrote to his colleague. “My advice based on that admission is that you have little choice but to cancel.”

Dr. Alireza Atef-Zafarmand

The News reported in February that UTSW helped another physician whom government investigations had implicated in abuse. Dr. Alireza Atef-Zafarmand was put on probation but allowed to graduate from a training program in 2007 despite findings that he sexually harassed female co-workers at one hospital — which fired him — and tried to hypnotize a female technician at another. After graduation, UTSW endorsed him for work at Dallas-area hospitals, with one of his supervisors ranking his ethics as “excellent.”

The U.S. Supreme Court ruled Monday on a 2010 discrimination dispute between Dr. Naiel Nassar and UT Southwestern Medical Center. In a 5-4 decision, the high court sent the case back to a lower court.

Nassar, an Egyptian-born Muslim physician, had claimed he suffered ethnic discrimination while working for the university, and then faced retaliation when he tried to get a job at Parkland Memorial Hospital. A Dallas jury ruled in Nassar’s favor, and UT Southwestern appealed. The case worked its way up to the nation’s highest court.

The majority opinion held that the jury should have been told that discrimination had to be the only reason for retaliation, not just one reason. Read more about the case and its implications for workplace discrimination complaints here, and the majority and dissenting opinions here.

Atef-Zafarmand has denied wrongdoing in previous interviews with The News. A lawyer who represented him in a medical board hearing Friday did not respond to a request for comment today.

Atef-Zafarmand “got angry during the hearing, at one point wagging his finger, pointing his finger at the [state's] attorneys and disparaging the character of the witnesses,” said board spokeswoman Leigh Hopper. “He cast himself as the victim.”

But “the evidence showed an escalating pattern of predatory and assaultive behavior,” Hopper said. “It appeared he has been using his medical license to mislead and gain control over women.” Continue reading →

The U.S. Supreme Court heard arguments yesterday for and against throwing out a Dallas jury’s finding that UT Southwestern discriminated against an Egyptian-born Muslim doctor, Dr. Naiel Nassar.

We wrote about the case in May of 2010, when a jury decided that UT Southwestern should award Nassar $3.6 million for suffering discrimination and retaliation at the hands of the university. In a lawsuit, Nassar had claimed that his boss, Dr. Beth Levine, pressured him to improperly bill for medical care and told him she thought people from the Middle East were lazy. Levine denied making disparaging remarks.

Nassar complained about Levine. When he later sought a job at Parkland Memorial Hospital, Nassar claimed UT Southwestern retaliated for his complaints by discouraging the job offer. Nassar ultimately left the university and took a job in California.

Following the trial, UT Southwestern issued a statement disagreeing with the verdict, and vowed to appeal. It did, and the case has worked its way up to the country’s highest court.

The fund-raising executive from UT Southwestern Medical Center phoned first. Then she sent an urgent email to the president’s office about the patient.

“We need to expedite care,” Cynthia “Cyndi” Bassel wrote last year. She asked the president’s aide whether he would call two of the patient’s UTSW doctors “to help speed things along.”

“If not,” Bassel said in the email, “I can handle.”

Such emails, which we recently obtained, shed new light on the intersection of medicine and fund-raising at UTSW.

We first learned of that in 2007, after receiving a leaked UTSW list of people designated for favored treatment. The state-supported institution had insisted VIPs didn’t get better or faster care at its university hospitals — just “non-medical courtesies,” such as free valet parking and an unlisted after-hours number to reach doctors.

In response to the emails, UTSW spokeswoman Nimisha Savani said all patients receive the “same prompt attention” and “in no instance is a physician asked to ‘bump’ a patient to accommodate one of these requests.” (Full response here.)